Get New Patient Intake Form - Eoshealth - Health Usf

Completing the New Patient Intake Form is essential for ensuring that you receive tailored care during your visit. This guide provides straightforward, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to successfully complete the New Patient Intake Form.

1. Press the ‘Get Form’ button to obtain the digital form and open it in your preferred editor.
2. Begin by entering your full name in the designated field. Subsequently, enter your preferred name if applicable.
3. Indicate your gender by selecting Male or Female. Next, provide the name of the person who referred you to the center, if applicable.
4. In the consultation information section, include the name and phone number of your referring physician.
5. Complete the emergency contact section by providing the name and relationship of a local friend or relative, along with two contact numbers.
6. Explain the primary reason for your visit by selecting from the provided options related to diabetes care.
7. Address any specific concerns or topics you wish to discuss during the appointment in the provided text area.
8. Indicate whether you monitor your blood glucose and provide details about your meter, frequency of testing, and patterns observed.
9. If applicable, answer questions related to pregnancy, past diabetes education, and any medications you are currently taking or have taken in the past.
10. Provide comprehensive information regarding your family health history related to diabetes and any other illnesses.
11. Fill in personal health details including any medical conditions, treatments, medications, or allergies.
12. Finalize the intake form by reviewing your entries for accuracy. After confirming all required fields are complete, save your changes, and download or print the form for submission.

Complete your New Patient Intake Form online today to ensure a smooth visit to the health center.